Multi-lobe artificial spine joint

ABSTRACT

An artificial disc is provided which more closely matches the movement of the natural spine. The artificial disc uses one or more projections and corresponding recesses to provide a sliding articulation. The artificial joint is inherently stable in that compressive forces placed on the disc such as the weight placed upon the joint or the tension of surrounding tissues urges the joint towards a neutral position and not farther away from a neutral position.

RELATED APPLICATIONS

The present application claims the benefit of U.S. ProvisionalApplication Ser. No. 60/889,217, filed Feb. 9, 2007, which isincorporated herein by reference in its entirety, and U.S. ProvisionalPatent Application Ser. No. 60/914,469, filed Apr. 27, 2007, which isincorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION

1. The Field of the Invention

The present invention relates to artificial joints, and in particular toan artificial inter-vertebral disc for replacement of damaged spinaldiscs. The present invention relates to an improved artificialinter-vertebral disc for both total disc replacement and for nuclearreplacement.

2. State of the Art

Artificial joints are increasingly becoming more common for the medicaltreatment of degenerated boney joints. Joints may become damaged due toaccidents, diseases, aging, etc., and are often replaced when the painis sufficient, or when natural motion of the joint is sufficientlyimpaired. Artificial joints commonly replace the tissue betweenadjoining bones, and may often replace the ends of the two adjoiningbones which form the joint.

In replacing a joint, there are generally several desirable outcomes tobe achieved. These outcomes include: stability, load bearing capability,natural motion preservation, pain relief, and reduced failure rates andreduction in catastrophic failure. Due to the complexity of the humanspine, stability has been a very difficult parameter to address. Oftenthis instability manifests itself as additional wear and prematurefailure of the artificial joint or supporting physiological structures,adjacent segment/joint degeneration, and exacerbating the pain anddisability of the patient.

A number of artificial discs which are presently available tend to lackthe stability of the natural spine. Many total disc replacement devices(TDR) are of the “ball in cup” or “ball in trough” design. One of theproblems of these particular designs is that the TDR requires thesurrounding tissues and structures (ligaments and joints) to providesupport and stability. Due to the physical geometry of these designs,the further the spine is moved from the “neutral position” the more theartificial joint has a tendency to continue moving in that direction,thus applying un-natural stress on the surrounding tissues andstructures and requiring greater forces to return the joint to the“neutral position.” Over time, the constantly applied and increasedloads required to operate the artificial joint may lead to damage to themuscles, connected tissues and adjacent structures of the spine,exacerbating the pain and hampering proper movement of the spine. It hasalso been discovered that, due to the instability of the replaced disc,the spine can develop scoliosis, or curvature, which tends to lead toadditional deterioration of the tissues associated with the spine, suchas failure of adjacent joints.

The neutral position for a joint is the normal resting position for thejoint, and is typically in the middle of the range of motion for aspinal joint. For a typical spine, two adjacent vertebral bodies haveendplates which are approximately parallel in the neutral position.

Another parameter that must also be controlled is the ability to mimicthe natural kinematic motion of the spine. Many joints in the human bodycan be adequately approximated by simple joints such as a hinge or aball in socket. Because of the complex construct of the spinal joint, itcannot be approximated by simple joints. Many prior artificial discsallow the vertebrae to move in a pivotal motion having symmetricalmovements. The differences in movement between a natural joint and anartificial joint can cause undesirable effects on the surrounding muscleand tissue. This can cause a degeneration and inability to properly moveand control the artificial joint accentuating the instability of theartificial joint, and may accelerate further joint problems.

There is a need for an artificial joint that is more energeticallystable with the inherent tendency to return the joint to a “neutralposition” in order to reduce the stress and fatigue on the surroundingtissues and structures. Additionally, there is additional need for theartificial joint to more accurately match the natural kinematic motionof the spine to reduce stress and fatigue again on the surroundingtissues and structures. These are but two parameters important todesigning a successful spinal disc replacement.

SUMMARY OF THE INVENTION

The objective of the present invention is to provide an improvedartificial disc. One objective of the invention is to create anartificial disc that more closely matches the movement of the naturalspine. To closely match the natural motion of the spine, one methodwould be to use non-congruent articulating surfaces that allow forasymmetrical and/or coupled movement. Such an artificial disc wouldpromote long term success of the replaced joint as it maintains morenatural motions of the muscles and tissues surrounding the joint. Bymore closely matching the natural movement, the artificial disc helpsprevent degeneration of surrounding tissues and adjacent segment, whilepromoting better patient mobility of the joint.

A further objective of the present invention is to provide an artificialdisc which is more energetically stable. When displaced from a neutralposition, the compressive forces naturally applied to the spine such asfrom gravity and the tension in surrounding tissues urges the artificialjoint back into a neutral position and not away from a neutral position.Such an artificial joint is especially beneficial where multiple discsare replaced as it avoids tissue fatigue and joint instability.

These and other aspects of the present invention may be realized in anartificial disc which uses a plurality of projections to engage a matingsurface to allow naturally constrained translational and rotationalmovement between two adjacent vertebrae. The mating surface typicallyincludes a plurality of recesses which receive the projections. Theprojections are able to slide within the recesses to provide bothtranslational and rotational movement, i.e. flexion/extension, lateralbending, and axial rotation. The projections and recesses are preferablyconfigured to provide coupled translational and rotational movement,causing tilting of a joint member as it slides across the mating jointmember. One or more of the projections may also be able to risepartially out of the recess, typically by engaging a wall or slopingportion of the recess, thereby providing an energetically stable system.

Alternatively, other structures such as a single projection and recesshaving multiple engagement surfaces as described herein may provide thedesired relative movement between the top and bottom of the artificialjoint. Likewise, intermediate structures between the top and bottom ofthe artificial joint may be used to provide the desired motion andstability.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present invention are shown and described inreference to the numbered drawings wherein:

FIG. 1 shows a side view of an art artificial joint in accordance withprinciples of the prior art;

FIG. 2 shows a side view of a spine having multiple prior art artificialjoints;

FIG. 3 shows a top view of a vertebra of a human;

FIG. 4 shows a schematic side view of two vertebrae illustrating thevertebral motion in forwards and backwards flexion of the spine;

FIG. 5A shows a schematic top view of a vertebra illustrating thevertebral motion in lateral bending of the spine;

FIG. 5B shows a schematic side view of two vertebrae illustrating thevertebral motion in lateral bending of the spine;

FIG. 6A shows a schematic top view of a vertebra illustrating thevertebral motion during rotation of the spine;

FIG. 6B shows a schematic side view of two vertebra illustrating thevertebral motion in rotation of the spine;

FIGS. 7A and 7B show the motion of the prior art artificial joint ofFIG. 1 in flexion and rotation;

FIG. 8 shows a disassembled perspective view of an artificial disc ofthe present invention;

FIG. 9 shows a partially cut-away top view of an artificial disc of thepresent invention taken along line 9-9 of FIG. 8;

FIG. 10 shows a side view of the base portion of the artificial disc ofFIG. 9;

FIG. 11 shows a top view of a base portion and a cross-sectional view ofthe projections of an artificial disc of the present invention;

FIG. 12 shows a top view of a base portion and a cross-sectional view ofthe projections of an artificial disc of the present invention;

FIG. 13A shows a cross-sectional view of the artificial discs of FIGS. 8through 12 taken along line 13-13 of FIG. 12;

FIG. 13B shows another cross-sectional view of the artificial disc of13A, with the projections having been moved in the troughs to therebychange the angle of the upper portion of the artificial disc;

FIG. 13C shows another cross-sectional view of an artificial disc of thepresent invention;

FIG. 14A shows a cross-sectional view of the artificial discs of FIGS. 8through 12 taken along line 14-14 of FIG. 12;

FIG. 14B shows another cross-sectional view of the artificial disc ofFIG. 14A, with the projection having been moved in the trough to therebychange the angle of the upper portion of the artificial disc;

FIG. 15 shows a cross-sectional view of the artificial discs of FIGS. 8through 12 taken along line 15-15 of FIG. 12;

FIG. 16 shows a close-up cross-sectional view of a projection and troughof the artificial disc of the present invention;

FIG. 17 shows another detailed cross-sectional view of a projection andtrough of the artificial disc of the present invention;

FIG. 18 shows another top view of the lower portion and projections ofthe upper portion of an artificial disc of the present invention;

FIG. 19 shows another top view of an artificial disc of the presentinvention;

FIG. 20 shows a cross-sectional view of the artificial disc of FIG. 19taken along line 20-20;

FIG. 21 shows a perspective view of an artificial joint of the presentinvention having differently shaped projections;

FIG. 22 shows a cross-sectional view of the artificial joint of FIG. 21taken along line 22-22 of FIG. 21;

FIG. 23 shows a perspective view of another artificial joint of thepresent invention;

FIG. 24 shows a cross-sectional view of the artificial joint of FIG. 23taken along line 24-24 of FIG. 23;

FIG. 25 illustrates another artificial joint of the present invention;

FIG. 26 shows an artificial joint of the present invention used as adisc nucleus replacement;

FIG. 27 shows an artificial joint having a restraining band according tothe present invention;

FIG. 28 shows a cross-sectional view of another artificial joint of thepresent invention;

FIG. 29 shows another cross-sectional view of the joint of FIG. 28;

FIG. 30 shows an exploded perspective view of a artificial joint similarto that of FIGS. 8-18;

FIG. 31 shows a bottom view of the upper portion of the joint of FIG.30;

FIGS. 32 and 33 show cross sectional views of the upper portion of thejoint of FIG. 30 taken along section lines 32 and 33 of FIG. 31;

FIG. 34 shows a bottom perspective view of the upper portion of thejoint of FIG. 30;

FIG. 35 shows a top view of the lower portion of the joint of FIG. 30;

FIG. 36 through 39 show cross sectional views of the lower portion ofthe joint of FIG. 30 taken along section lines 36 through 39 of FIG. 35;

FIG. 40 shows a perspective view of the lower portion of the joint ofFIG. 30;

FIG. 41 shows an exploded perspective view of an artificial jointsimilar to that of FIGS. 8-18, and 30-40;

FIG. 42 shows a bottom perspective view of the upper portion of thejoint of FIG. 41;

FIG. 43 shows a bottom view of the upper portion of the joint of FIG.41;

FIG. 44 through 47 show cross sectional views of the upper portion ofthe joint of FIG. 41 taken along section lines 44 through 47 of FIG. 43;

FIG. 48 shows a perspective view of the lower portion of the joint ofFIG. 41;

FIG. 49 shows a top view of the lower portion of the joint of FIG. 41;

FIG. 50 through 53 show cross sectional views of the lower portion ofthe joint of FIG. 41 taken along section lines 50 through 53 of FIG. 49;

FIG. 54 shows an exploded perspective view of an artificial jointsimilar to that of FIGS. 8-18, 30-40, and 41-53;

FIG. 55 shows a bottom perspective view of the upper portion of thejoint of FIG. 54;

FIG. 56 shows a bottom view of the upper portion of the joint of FIG.54;

FIG. 57 through 60 show cross sectional views of the upper portion ofthe joint of FIG. 54 taken along section lines 57 through 60 of FIG. 56;

FIG. 61 shows a perspective view of the lower portion of the joint ofFIG. 54;

FIG. 62 shows a top view of the lower portion of the joint of FIG. 54;

FIG. 63 through 66 show cross sectional views of the lower portion ofthe joint of FIG. 54 taken along section lines 63 through 66 of FIG. 62;

FIG. 67 shows a top view of the lower portion of the joint of FIG. 54along with the tool path lines for forming the recesses; and

FIG. 68 shows a perspective view of the tool path lines, surfaces formedby the tool and recesses of FIG. 67.

It will be appreciated that the drawings are illustrative and notlimiting of the scope of the invention which is defined by the appendedclaims. The embodiments shown accomplish various aspects and objects ofthe invention, and any single figure need not accomplish each aspect oradvantage of the invention. It is appreciated that it is not possible toclearly show each element and aspect of the invention in a singlefigure, and as such, multiple figures are presented to separatelyillustrate the various details of the invention in greater clarity.

DETAILED DESCRIPTION

The invention will now be discussed in reference to the drawings and thenumerals provided therein so as to enable one skilled in the art topractice the present invention. The drawings and descriptions areexemplary of various aspects of the invention and are not intended tonarrow the scope of the appended claims. In some figures, space is shownbetween adjacent structures which are normally in contact with eachother in order to more clearly show the structures.

Currently, a number of artificial discs are presently available or beingtested. These tend to lack the stability of the natural spine. Theseprior art joints typically include a bearing surface which includes acup shaped receptacle on top of a spherical surface or a ball orspherical surface 10 placed in a cup shaped receptacle 14, as shown inFIG. 1. These joints move by pivoting in a manner similar to other knownball and socket joints. Rectangle 18 generally indicates body mass abovethe joint (as is supported by the particular joint), such as additionalvertebrae, bones, and tissue. Circle 22 indicates a piece of the bodyweight above the joint, providing a reference point for illustrativepurposes. As the ball 10 pivots into position 10′, as would occur withthe bending of the joint (where the person having the artificial jointis bending), body mass 18 and reference point 22 move to the locationsindicated by 18′ and 22′. It is appreciated that the position 22′ is ata lower vertical height that position 22.

It is thus appreciated that as the joint pivots by rotating ball 10,there is a general lowering of point 22 as it is moved to position 22′.The pivoting of the joint is favored by gravity, as the body mass 18, 22above the joint is moved into a lower position. Gravity alone will applya force to continue the movement, moving the body mass 18, 22 into aneven lower position. Additional force is required to move the body mass18, 22 back into its original position. The spine is in a state ofcompression due to the force of gravity acting on body mass above eachjoint and due to the tension of the muscles and other tissuessurrounding each joint. These compressive forces tend to move the priorart artificial joints away from a neutral position, as the end points ofmotion represent minimum energy states, i.e. positions where thegravitational potential energy and tensile forces are minimized.

Thus, it is appreciated that the joint shown is a joint which isinherently unstable. Once moved off of a neutral position, compressionon the joint as caused by the tension in surrounding tissue or theweight of the body above the joint tends to continue the movement. Theprior art joint is stable at the end points of motion rather than in themiddle position, meaning that compressive forces on the joint tend tomove the joint to the end points of motion rather than to a centerposition.

The muscular structure and other tissue structures surrounding the priorart joint must hold the joint in a neutral position (i.e. a restingposition where the joint is not displaced, where surrounding muscles andtissue are at resting length) against the compressive forces acting uponthe spine, such as the force of gravity. As the spinal joints are seldomin a precisely neutral position, the surrounding muscles and tissues mayundergo a considerable amount of stress in attempting to hold such anartificial joint in a desired position, such as when the person issitting or standing vertically. Additionally, the surrounding musclesand tissues must work harder to return the joint to the neutral positionafter the bending of the spine. This, in turn, can lead to damage to themuscles, connected tissues and adjacent joints/structures of the spine,exacerbating the pain and hampering proper movement of the spine.

It can thus be understood how it is desirable to have an artificial discwhich is energetically stable. It is desirable to have an artificialjoint where the compressive forces acting on the spine such as the forceof gravity acting on the body mass and weight above the joint tend tomove the joint back to a neutral position and not away from a neutralposition.

FIG. 2 shows an example of a person's spine which has two or more of theartificial discs of FIG. 1. A plurality of vertebrae 30 a-30 g andhealthy vertebral discs 34 a, 34 b, 34 e, 34 f are shown. The naturalvertebral discs between vertebrae 30 c and 30 d, and between vertebrae30 d and 30 e have been replaced by prior art artificial discs 38 c and38 d, including ball and trough discs as discussed with respect toFIG. 1. As has been discussed, ball and trough discs present inherentinstability, where compressive forces such as gravity accentuatemovement and pull the joint farther from a neutral position instead ofreturning the joint to a neutral position.

The problem is increasingly severe with two or more artificial discs asis shown with 38 c and 38 d. When one artificial disc, such as 38 d, ismoved from a neutral position, the forces of gravity, unbalanced tensionof the body tissues surrounding the spine, etc. cause the secondartificial disc 38 c to pivot in the opposite direction of 38 d. Apatient having multiple prior art artificial discs may not be able tomaintain their spine in a proper alignment or posture as the artificialdiscs tend to urge the spine into a bent or collapsed position. Thus,the spine either develops a scoliosis, or curvature, due to theinstability of the artificial discs 38 c, 38 d, and the inability of thebody to hold the spine in a proper position, or significantly morestress is placed on the muscles and connective tissue in order for thebody to hold the spine in its proper orientation. Over time, the bendingor collapsing of the spine due to the artificial discs tends todeteriorate the tissues associated with the spine. It is thusappreciated that where an artificial disc lacks a natural stability, thelong term success of the artificial joint is reduced, and isdramatically reduced with increasing numbers of discs being replaced. Infact, the artificial joint may accelerate the failure of otherwisehealthy spinal components.

A spine having a single prior art artificial disc may result in aundesired and excessive bending of one or more adjacent natural discs,resulting in a spinal shape similar to that shown in FIG. 2. Theundesired bending of the natural discs adjacent to the artificial jointmay cause or accelerate degradation of the natural joints, and mayresult in the need to replace additional discs.

A further concern of an artificial disc is the preservation andrestoration of a natural motion. Providing natural motion with anartificial joint is important for multiple reasons, such as providingcomfortable movement to the person. Perhaps more important is the effectthe artificial joint can have on the surrounding tissue. If the motionis unnatural, the tissues responsible for moving the joint, such as thesurrounding muscles, tendons, etc. may be adversely affected by thejoint. The surrounding tissue may be unable to properly control thejoint, or may gradually degenerate due to the changed movement of theartificial joint. Thus, providing an artificial joint with a naturalmotion can have a significant effect on the long term success of anartificial joint.

Many artificial joints, such as artificial knees or hips, are relativelysimple joints with relatively simple motion, such as hinge or ball insocket type joints. Vertebrae and the natural discs, however, have acomplex motion. The natural discs are a soft pad, not unlike a mattress.The natural discs allow for and support the movement of the vertebrae,and allow the vertebrae to shift across the disc with combinations ofhorizontal, vertical and rotational movement to accomplish the normalmovements of the spine.

Prior art artificial discs such as that shown in FIGS. 1 and 2 do notmatch the natural movement of the spine well. Many prior art artificialdiscs allow the vertebrae to move in a pivotal motion, and havesymmetrical forwards and backwards movement. As has been mentioned, thedifferences in movement between a natural joint and an artificial jointcan cause undesirable effects on the surrounding muscle and tissue. Themuscle and tissue are oriented and accustomed to move the joint in anatural motion, and may degenerate or be unable to properly control theartificial joint having an unnatural motion. This degeneration andinability to properly move and control the artificial joint accentuatesthe instability of the prior art artificial joint, and may cause oraccentuate the joint problems discussed with respect to FIGS. 1 and 2.

It can thus be appreciated how it is desirable to have an artificialdisc which results in a joint which is energetically stable and whichprovides a natural motion. Achieving such results provides an artificialdisc and resulting joint which minimizes adverse effects on the bodysuch as degradation of the surrounding tissues responsible forcontrolling the joint and the failure of the joint to provide support tothe body in a natural position.

A study of the movement of the cervical spine (the neck) reveals thatthe kinematic motion of the spine is a complex and asymmetricalmovement. The movement of the spine is observed to be a coupling oftranslational and rotational motion of the vertebral bodies. Herein, themotion of the spine is typically described by describing the motion ofthe portion of the vertebral body above the relevant spinal discrelative to the corresponding portion of the vertebral body below thedisc. Flexion/extension involves the translation of the vertebral bodyforwards or backwards in combination with rotation of the vertebral bodyin the same direction of translation. Rotation typically involvesrotation of the vertebral body about a point somewhat behind the centerof the vertebral body in combination with some lifting and some sidewaystilting, the vertebral body tilting to the left somewhat during a leftrotation, etc. Lateral bending (side to side) is accomplished bycooperation of multiple vertebral joints in a combination of rotation,flexion/extension, and lateral tilting. The motion of the natural spinehas been described by: Panjabi et al, Spine. 2001 Dec. 15;26(24):2692-700; Ishii et al., Spine. 2006 Jan. 15; 31(2):155-60; Ishiiet al, Spine. 2004 Dec. 15; 29(24):2826-31; and Ishii et al, Spine. 2004Apr. 1; 29(7):E139-44.

FIG. 3 shows a top view of a vertebra 50. The vertebra includes variousstructures for the attachment of surrounding tissue, the passage of thespinal column, etc. As the present invention concerns the vertebraldiscs and providing an artificial disc, the drawings and discussion ofthe vertebra will typically be limited to the vertebral body, therounded frontal area indicated at 50 a which connects to the vertebraldisc. Thus, the present application shows the vertebral bodies asrounded or cylindrical sections for simplicity. The posterior (back) ofthe disc area of the vertebra is indicated at point 54, and the anterior(front) is indicated at 58. The facet joints 52 aid in controlling themotion of the natural spine as is generally understood. These points arereferred to in discussing the movement of the vertebra.

FIG. 4 shows a side (lateral) view of two vertebrae, showing typicalmovements of a cervical vertebra in flexing forwards and backwards. Itis observed that the posterior 54 and anterior 58 of the vertebra 50move differently relative to vertebra 46. The anterior 58 of vertebra 50exhibits a greater amount of vertical movement than the posterior 54 ofvertebra 50. It is also observed that the movement of vertebra 50involves a considerable amount of sliding movement relative to vertebra46. The disc 62 between the vertebrae is quite conforming, and changesshape to allow for the movement of the vertebrae, such as for theforward and backward movement of the vertebra 50. While the presentinvention discusses the artificial joint in the context of a joint forcervical disc replacement, it will be appreciated that it may be usedfor replacing other spinal discs as well, typically by modifying thesize of the artificial joint and possibly by modification of the shapeof the projections and recesses slightly to control the motion andachieve a desired range of motion.

FIG. 5A shows a top view of vertebra 50, illustrating the horizontalmovement of various points of the vertebra during lateral bending. Theposterior 54 of the vertebra 50 remains in substantially the samelocation during lateral bending. The anterior 58 and center 66 of thevertebra 50 pivot relative to the posterior 54 of the vertebra, movingin arcuate movements as indicated by arrows 70 and 74. The left side 78and right side 82 of the vertebra 50 also move in arcuate movements asthough pivoting around the posterior 54 of the vertebra, indicated byarrows 86 and 90.

FIG. 5B shows a front view of the vertebra 50, illustrating the verticalmovement of various points of the vertebra during lateral bending.Vertebra 46 and disc 62 are also shown so as to illustrate the movementof vertebra 50 relative to vertebra 46. In lateral bending, the anterior58 of vertebra 50 moves horizontally relative to vertebra 46, asindicated by arrow 94. Left side 78 and right side 82 of vertebra 50move vertically as well as horizontally, as indicated by arrows 98 and102.

As illustrated by FIGS. 5A and 5B, lateral bending of the vertebra 50 isa complex movement. The vertebra 50 both slides and twists sideways. Thevertebra 50 slides across the disc 62, pivoting around a posterior point54 of the vertebra 50. As the left side 78 or right side 82 of thevertebra 50 move sideways, they move vertically, twisting the vertebra50 relative to vertebra 46. As mentioned above, lateral bendingtypically involves coordinated movements of multiple spinal joints toachieve the desired movement. FIGS. 5A and 5B describe a desiredmovement of a single spine joint in order to accommodate the naturallateral bending of the spine.

FIG. 6A shows a top view of the vertebra 50 illustrating the horizontalmovement of various points of the vertebra during rotation of thevertebra 50. The vertebra 50 rotates about a point 66 slightly behindthe center of the vertebra. As such, the anterior point 58, posteriorpoint 54, and lateral points 78, 82 move according to arrows 56, 60, 80,84 as shown. FIG. 6B shows a front view of the vertebra 50 as well asvertebra 46 and disc 62, illustrating the horizontal movements of thevertebra 50 during rotation thereof. The vertebra 50 undergoes somevertical lifting as wells as tilting towards the side of rotation (i.e.tilting to the left side during a left rotation) as is indicated byarrows 96, 100, 104.

Prior art artificial discs, such as that shown in FIG. 1, involve a balland socket type configuration, or a hemispherical disc between twosockets, etc. It is appreciated that the prior art artificial vertebraof FIG. 1 does not move in a similar fashion as the natural vertebra asdiscussed in FIGS. 3-6. FIG. 7A shows the movement of the prior artartificial disc which is typical to both flexion/extension and lateralbending. The posterior 106 and anterior 110 of the upper vertebralsurface 10 move according to the arrows 114, 118. It is appreciated thatthis movement is quite different than the flexing movement and lateralbending movement of the natural spine as shown in FIG. 4. The lateralbending movement of the artificial disc is similar to the flexingmovement, whereas the natural spine bends laterally with a combinationof rotation and flexing movement. The compressive forces present in thebody (such as the weight of the body and the tension of the muscles andtendons, etc.) tend to return a natural vertebra to a neutral flexingposition, where compressive forces applied to the prior art artificialdisc tend to move the prior art disc to an extreme flexing or bendingposition, away from the neutral position.

FIG. 7B shows a top view of the prior art artificial disc of FIG. 1illustrating the rotational movement of the resulting joint. The uppervertebral surface 10 pivots about the center 122 as shown by arrows 126.The ball and socket type artificial disc pivots about the center of thedisc and pivots without any vertical movement of the disc. As shown inFIGS. 5 and 6, a natural vertebra pivots about a point more towards therear of the disc in combination with some lifting and tilting, which theprior art artificial discs do not adequately replicate. The compressiveforces present in the body (such as gravity and muscle tension, etc.)bias the natural vertebra into a neutral pivotal position, while theprior art artificial vertebra is not biased into a neutral position.

It is thus better appreciated how the prior art artificial disc resultsin joints which lack inherent stability (can not center themselves orare not biased to a neutral position by the natural compressive forcesacting on the spine) and which fail to recreate the movement of thenatural spine. Both of these factors result in unnatural movement andplace additional stress on the muscles, connective tissues, andsupporting joints which operate the particular spinal joint. Thus, theprior art artificial disc can contribute to further failure of thespine.

Turning now to FIG. 8, a disassembled perspective view of an artificialjoint 130 according to the present invention is shown. The joint 130includes an upper portion 134 having a plurality of projections 138 a,138 b, 138 c (generally 138) and a lower portion 142 having a pluralityof recesses 146 a, 146 b, 146 c (generally 146). The projections 138 arereceived in the recesses 146 when the artificial joint is assembled toreplace a disc in the spine. The recesses 146 define the surface whichthe projections 138 contact and define the possible ranges of movementof the projections, and thus the movement of the upper surface 134relative to the lower surface 142. The interaction between the surfaceof the projections and the surface of the recesses provides controlledmovement of the artificial joint 130 which more closely resembles themovement of the natural spine.

In showing the present invention in the following figures and indiscussing the present invention, the recesses and projections are oftendenoted by a bounded area. It is appreciated from the followingdiscussion and figures that the projections and recesses are oftensmoothly contoured and transition gradually from the surroundingmaterial. Thus, there may not be a sharply defined edge to theprojection or recess. The defined boundaries of the recess, for example,may represent the area in which the projection is intended to move, orthe area which contacts the projection during expected use of theartificial joint. In some configurations of the artificial joint, theprojection or recess may have a more sharply defined edge, such as whena retaining wall is used to provide a positive limit to the range ofmotion of the artificial joint. In other configurations, the recess maybe unbounded or have no distinct edge, and may have another structuresuch as a pin to limit the movement of the upper surface relative to thelower surface. Thus, it is understood that the term recess is usedbroadly to define the general area or portion which receives aprojection, and is not intended to limit the structure to a structurehaving opposing sidewalls or an elongate nature.

The following figures and description will better describe the profilesof the projections 138 and recesses 146 and the resulting range andtypes of movement allowed by the artificial disc 130. It will beappreciated by the figures and discussion that the recesses 146 need notnecessarily have steeply sloped vertical edges to as to absolutelycontain the projection 138, but may present a gradual transition fromthe adjacent surface of the lower surface 142. The term recess is usedto describe the surfaces which are contacted by the projections 138 andacross which the projections slide to allow for movement of theartificial disc 130.

The upper surface 132 of the upper portion 134 and the lower surface 144(not visible) of the lower portion 142 are configured for attachment tobone to thereby form an artificial joint. Thus, the attachment surfaces132, 144 may have spikes, porous structure, chemicals to induce bondingto the bone, etc. as is known in the prior art. These surfaces are notdetailed in every drawing, but are understood to be part of all of theartificial joints disclosed herein as may be necessary. Additionally,the base of the upper portion 134 and/or lower portion 142 may betapered in thickness such that the resulting artificial disc 130 iswedge shaped and not flat. A wedge shaped artificial disc is useful inaddressing lordosis, kyphosis, scoliosis, or other conditions present ina patient's spine. The use of artificial joint elements having a taperedthickness so as to produce a wedge shaped artificial disc is understoodto be part of all of the artificial joints disclosed herein. It will beappreciated that such attachment structures or tapering thicknesses maynot be necessary in all situations, or may often be of a different sizeor configuration, especially in situations such as where the artificialjoint is sized for a nuclear replacement.

FIG. 9 shows a partially cut-away top view of the joint 130,illustrating one possible configuration of the projections 138 andrecesses 146. The lower portion 142 and recesses 146, as well as across-sectional view of the projections 138 are visible. The remainderof the upper portion 134 is omitted for clarity. (While discussed inthis application as the projections extending downwardly from the upperportion into the recesses in the lower portion, it will be appreciatedthat the configuration can be reversed so that the projections extendupwardly from the lower portion into receptacles in the upper portionwhile maintaining the stability discussed herein).

FIG. 9, and many of the following figures are taken along line 9-9 ofFIG. 8, and are used to indicate the shapes and orientation of theprojections and recesses and configuration of the artificial joint.

The projections 138 are formed as hemispherical projections on the upperportion 134, and are illustrated with cross-hatching to distinguish fromthe recesses 146. The recesses 146 are formed in the lower portion 142.The recesses may be formed as hemispherical recesses, or may be formedas oval, kidney, or egg shaped recesses. For example, the anteriorrecess 146 a may be formed as an oval recess having a long axisextending sideways. The lateral recesses 146 b, 146 c may be formed asoval recesses having a long axis extending somewhat parallel to theadjacent edge of the lower layer 142. Regardless of the shape, it ispreferred that the recesses be larger from side to side than adjacentportions of the associated projection so that the projection is providedsome degree of translational movement prior to engaging the sidewalls(which are generally sloped rather than vertical) of the recesses.

As is more specifically illustrated in subsequent figures, thereceptacles are typically contoured to control the movement of theresulting artificial joint. Typically, the bottom portion of thereceptacles 146 is relatively flat to allow some translational movement,and the inward sides of the receptacles are increasingly sloped to causea lifting of the upper portion 134 as a particular side thereof slidestowards the center of the lower portion 142. The outer portions of thereceptacles 146 may simply continue in the direction of the lowerportion of the receptacles, or may contain a retaining wall or steeplysloped surface which limits the motion of the artificial joint 130. Itis not intended that the projections 138 will climb such a sloped outerportion of the receptacles 146 so as to lift the side of the upperportion 134 which is moving away from the center of the lower portion142 as such is typically contrary to the motion of the natural spine.

Additionally, the recesses 146 may be oriented at various angles to aidin controlling the movement of the joint. The anterior recess 146 a maybe oriented so as to be directed somewhat forwards rather thancompletely vertically. The lateral recesses 146 b, 146 c, may beoriented somewhat backwards and out the lateral sides.

FIG. 10 shows a side view of the lower portion 142 of FIG. 9. It can bemore clearly seen how the anterior recess 146 a is oriented in aforwards direction rather than completely vertically, and how thelateral recesses 146 b (not shown), 146 c are oriented such that theyare tilted outwardly and backwards from a completely verticalorientation. The orientation of the recesses 146 aids in controlling themovement of the projections and upper portion; thus controlling themovement of the artificial disc 130. The movement of the artificial disc130 will be discussed in greater detail in the following figures anddescription.

FIG. 11 shows another partially cut-away top view of the artificial disc130, illustrating an alternate configuration of the projections 138 andrecesses 146. The projections 138 are formed so as to have sides whichare generally aligned in a radial alignment with a posterior point 150,as indicated by the dashed reference lines extending from the posteriorpoint 150. Similarly, the contours of the receptacles 146 generallyfollow those radial lines. Such a radial alignment encourages the discto rotate about the posterior point 150, imitating the movement of thenatural spine as discussed above.

As the disc rotates, the anterior projection 138 a moves laterally as isillustrated by arrow 148, and the lateral projections 138 b, 138 c moveas illustrated by arrows 152 and 156. As the upper portion 134 rotatesto the right, left lateral projection 138 c is raised vertically (out ofthe page) as it engages the sidewall of the recess, thereby imitatingthe tilting of the natural spine during rotation. When the upper surface134 is rotated to the left relative to the lower surface 142 the rightlateral projection 138 b is raised in a similar manner. These movementsare also shown in FIGS. 13-15.

FIG. 12 shows another partially cut-away view of the artificial disc130, illustrating an alternate configuration of the projections 138 andrecesses 146. The lateral projections 138 b, 138 c, and lateral recesses146 b, 146 c have been formed such that they are slightly curved. Thecurve encourages the upper portion 134 to rotate around point 154relative to the lower portion 142. The curved surfaces of the lateralprojections 138 b, 138 c, and lateral recesses 146 b, 146 c aid inconstraining the rotational movement of the disc 130 to a predeterminedmotion.

Point 154 is somewhat forward of the posterior portion (indicated atpoint 158) of the disc 130, but behind the center 162 of the disc. Asthe upper portion 134 of the disc 130 is rotated, the anteriorprojection 138 a moves according to arrow 166, and the lateralprojections move according to arrows 170 and 174. The shape of therecess 146 c cause the left lateral projection 138 c to be raisedvertically when the upper portion 134 is pivoted to the right, and theshape of the recess 146 b causes the right lateral projection 138 b torise when the upper portion is pivoted to the left—thus imitating thetilting of the natural spine when rotating.

FIG. 13A shows a cross-sectional view of the artificial discs 130 ofFIGS. 8 through 12 along line 13-13 (as indicated in FIG. 12). The crosssection shows both the upper portion 134 and lower portion 142 of theartificial disc 130 as included in FIG. 8, but the section line is shownin FIG. 12 for clarity in indicating the section shown. It can beobserved how the projections 138 b and 138 c have rounded lower surfacesto allow for smooth sliding movement (rotation and translation) acrossthe surfaces of the recesses 146 b, 146 c. The recesses 146 b, 146 c arealso smoothly formed, providing for smooth and continuous movementacross a desired range of movement. In a resting position the bottom ofthe projections 138 b, 138 c rest on the generally flat bottoms of therecesses 146 b, 146 c. Thus, the joint is highly stable, as it requiresno additional work for the joint to be held in a resting state. Thecompressive forces exerted on the joint, such as that of the weight ofthe body and the tension of surrounding tissues, will tend to bias thejoint into such a resting state. The joint's resting state isenergetically stable (an energetic minimum) and corresponds to theneutral position of the natural spine.

When the upper portion 134 is slid to the right relative to the lowerportion 142 (as occurs in the natural spine), the left projection 138 cis raised as it travels upwardly along the surface of recess 146 c. Theright projection 138 b moves generally horizontally across the generallyflat bottom of recess 146 b, resulting in a tilting of the upper portion134 to match that of the natural spine, and resulting in a net expansionof the artificial disc. Left movement of the upper surface 134 causesthe right projection 138 b to be raised vertically along the sidewall ofthe recess 146 b, while the left projection 138 c slides generallyhorizontally, tilting the upper portion 134 to the left and resulting ina net expansion of the artificial disc. By matching the travel andcurvature of the projections 138 with the sidewalls of the recesses 146,the upper surface 134 can be made to closely resemble the travel whichoccurs in the natural spine. It is thus appreciated that the compressiveforces placed on the spine such as the weight of the body above theartificial joint and the tension in the tissues surrounding the naturalspine will urge the artificial joint back into the neutral position, asthese forces act to compress the artificial joint. The artificial joint130 is thus naturally stable as these compressive forces tend to returnthe upper portion 134 to its original neutral position. Thus, additionalfatigue is not placed on the muscles and connective tissue, increasingjoint stability.

FIG. 13B shows the artificial joint of FIG. 13A with the upper portiondisplaced slightly to the right. It can be seen how the projection 138 cis raised as it moves to the right and how the upper portion 134 istilted to the right. It can be seen how the average distance between theupper portion 134 and lower portion 138 is increased, resulting in a netexpansion of the artificial joint. Thus, compressive forces acting onthe joint 130 counteract the expansion of the joint and return it to aneutral position.

The expansion of the artificial joint caused by movement thereof may bedescribed in different ways. The volume occupied by the joint, includingthe volume of the upper portion 134, lower portion 138, and the spacedirectly therebetween, increases in response to displacement of thejoint from a neutral position. Alternatively, the mean distance betweenthe upper portion 134 and the lower portion 142 increases when the jointis displaced from a neutral position. While various different terms maybe used to describe the expansion of the joint 130, the design of theartificial spinal disc of the present invention is such that, for theintended range of motion of the resulting artificial joint, theartificial joint is expanded as a result of the displacement of thejoint from a neutral position and therefore compressive forces placed onthe artificial joint will bias the joint back into a neutral position.This produces a joint which is inherently stable as the forces normallyplaced on the joint while in use tend to restore the joint to a neutralposition. For the most preferred embodiments of the artificial joint,the joint experiences a net expansion for all types of desired movement,resulting in a joint where all types of movement are counteracted bycompression of the joint, and thus a joint where the compressionnaturally placed on the spine biases the joint into a neutral positionin reaction to all types of movement from neutral.

FIG. 13C shows an artificial joint similar to that of FIGS. 13A and 13B,but where the projections 138 (lateral projections 138 b, 138 c shown)are formed on the lower portion 142 and the recesses 146 (lateralrecesses 146 b, 146 c shown) are formed on the upper portion 134. It isseen that the direction of slope of the recesses 146 is reversed toachieve the same direction of tilt during movement of the artificialjoint 130. That is that where FIG. 13A shows recesses where the sectionsadjacent the outer edges of the lower portion are generally horizontaland the sections adjacent the interior of the lower portion are sloped,FIG. 13C shows recesses 146 where the sections adjacent the outer edgesof the upper portion 134 are sloped and the sections adjacent theinterior of the upper portion are generally horizontal. The arrangementshown in FIG. 13C ensures that the upper portion 134 is tilted forwardswhen extending forwards, etc. to match the natural movement of the spineas has been discussed.

It is thus appreciated that the artificial joints of the presentinvention may not always have projections 138 on the upper portion 134and recesses 146 on the lower portion 142, but may contain projectionson the lower portion and recesses on the upper portion, or a combinationof both projections and recesses on the upper portion and on the upperportion. Generally, when it is desirable to have a projection 138 on thelower portion 142 of the joint and a recess 146 on the upper portion 134of the joint, the relative orientation of the recess is reversed so thatsloping portions which were placed on the inside of the recess (nearestthe center of the joint) are placed on the outside of the recess andgenerally planar or less sloped portions which were placed on theoutside portion of the recess are placed on the inside portion of therecess. In most cases, however, it is easier to manufacture anartificial joint where the projections are on the top of the joint andthe recesses are on the bottom of the joint.

FIGS. 14A and 14B show cross-sectional views of the artificial discs 130of FIGS. 8 through 12 along line 14-14. The cross section shows both theupper portion 134 and lower portion 142 of the artificial disc 130 asincluded in FIGS. 8 through 12, but the section line is shown in FIG. 12for clarity in indicating the section shown. It can be seen how thelateral projections 138 b, 138 c (right lateral projection 138 b notshown) move upwardly as the upper portion 134 is moved forwards (towardsthe anterior of the lower surface 142). The lateral projection 138 b,138 c slides upwardly and forwards across the surface of the recess 146b, 146 c. Thus, the upper portion 134 is pivoted upwardly at the rearabout 5-7 degrees, thereby simulating the movement of the natural spine.The anterior projection 138 a, not shown, may either slide horizontally,or may even slide downwardly along the slope in the anterior recess 146to provide the diving motion at the front of the joint similar to anatural spine. Unlike prior art artificial joints, however, the joint isconfigured to return to its original position once the associatedmuscles are released, using the compressive forces acting on the jointto slide the projections 138 b and 138 c back down the sidewalls oftheir associated recesses, and to slide or raise the anterior projection138 a back to its original position.

FIG. 15 shows a cross-sectional view of the artificial discs 130 ofFIGS. 8 through 12 along line 15-15, with the addition of a motionlimiting post or stop which is not shown in the previous figures. Thecross section shows both the top and bottom of the artificial disc asincluded in FIGS. 8 through 12, but the section line is shown in FIG. 12for clarity in indicating the section shown. The anterior projection 138a and recess 146 a are visible. As the upper portion 134 moves backwards(towards the posterior of the lower surface) the anterior projection 138a is raised vertically as it slides up the inclined surface of therecess 146 a. In order to limit the movement of the upper portion 134relative to the lower portion 142, one of the upper portion and lowerportion may have a post 178 formed thereon (not shown in previousfigures) and the other portion may have a corresponding hole 182 orreceptacle to receive the post 178. Various different methods andstructures may be used to affirmatively limit the motion of theartificial joint.

The limiting of the movement of the post 178 to space defined by thehole 182 constrains the movement of the upper surface 134 relative tothe lower surface 142, and thus constrains the range of motion providedby the artificial disc 130. This may be important in preventing theartificial disc 130 from being dislocated (the upper surface 134 movingtoo far across or off of the lower surface 142) as may occur in anaccident or other forceful impact.

The movement of the cervical vertebrae is relatively small. For example,in flexing forwards and backwards, a vertebra may tilt forwards by about10 degrees and backwards by about 5 degrees. The same movement maytypically involve the vertebra sliding about 1 or 2 millimeters relativeto the vertebra below. In rotating, the vertebra may pivot by about 4degrees and slide about 0.5 or 1 millimeter relative to the vertebrabelow. Thus, the hole 182 may be about 4 millimeters larger than thediameter than the post 178.

FIGS. 13-15 illustrate how the recesses 146 are shaped to both directthe movement of the projections 138 into predetermined directions and toselectively raise one or more of the projections as the upper portion134 is moved. The projections are directed into movements which imitatethe motion of the natural spine. As the artificial disc 130 is flexedforwards, the upper portion 134 slides forwards and is also tiltedforwards as the lateral projections 138 b, 138 c are raised verticallyby recesses 146 b, 146 c.

As the artificial disc rotates, the projections 138 and recesses 146also aid in imitating the movement of the natural spine. For example,when the upper portion 134 is rotated to the right, the anteriorprojection 138 a will slide to the right, the left lateral projection138 c will slide to the left and somewhat forwards, and will be raisedvertically, and the right projection 138 b will slide to the left andslightly backwards. By controlling the shape of the projections 138 andthe shape and curvature of the bottom and sidewalls of the recesses 146,the three dimensional movements of the upper portion 134 and the lowerportion 142 can be carefully controlled. Thus, an artificial joint canbe created which much more closely simulates the movements of thenatural spine than the artificial joint of FIG. 1.

FIG. 16 shows a detailed view of a projection 138 and recess 146 of theartificial disc 130. Only one projection 138 and recess 146 are shownfor clarity, but the principles discussed apply to each of theprojection 138/recess 146 combinations. The recesses 146 may be formedwith a generally flat and horizontal lower section 186, a curvingtransitional section 190, and a more steeply inclined section 194. Theprojection 138 is formed with a rounded end 198 which may slide smoothlyacross the recess 146 including transitioning smoothly across thevarious sections of the recess. It will be appreciated that differentshapes of projections and recesses, such as curving sections 190 whichcurve more rapidly or slowly to increase the rate of rise of the upperportion 134 relative to the translational movement thereof, may be usedto alter the characteristic motion of the artificial joint.

The projection 138 may be located in a resting position in thetransitional section 190 of the recess, such that the projection 138will slide in a generally horizontal direction when sliding away fromthe inclined portion 194 (to the left in FIG. 16), and such that theprojection will immediately begin to move upwards as well ashorizontally as the projection slides towards the inclined portion ofthe recess 146 (to the right in FIG. 16). Such a configuration of theprojections 138 and recesses 146 may be used to create an artificialdisc which is self centering and energetically stable.

The projections 138 and recesses 146 may be oriented such that theprojections slide generally horizontally when sliding generally awayfrom the center of the lower portion 142, and such that the projectionsslide both horizontally and upwardly when sliding generally towards thecenter of the lower layer 142. Thus, when the artificial disc is movedforwards, as would occur in a forwards flexion of the spine, theanterior projection 138 a slides generally forwards and the lateralprojections slide both forwards and upwards across the transitionalportion 190 and inclined portion 194 of the lateral recesses 138 b, 138c. Thus, the posterior portion of the upper layer 134 of the artificialdisc 130 is raised upwardly, causing a rising of the body weight andtissue supported above the artificial disc 134. The raising of the upperportion 134 and the weight supported thereon is against the force ofgravity and against the tension of the muscles and tissues supportingthe spine. Thus, the compressive forces of the body weight placed on thejoint and the tension in the supporting tissue will cause the joint toreturn to a neutral position, lowering the elevated lateral projections138 b, 138 c and lowering the upper portion 134 and supported weight. Asimilar mode of operation is achieved in rotational movement of theartificial disc 130.

While discussed relative to forward flexion, it will be appreciated thateach recess 146 may be provided with sloped sidewalls about the entirecircumference, thereby selectively controlling the lifting of anassociated projection 138 in response to any direction of horizontalmovement. By matching the curvature of the projections 138 and thecurvature of the recesses 146, substantial control of the threedimension movement of the upper portion 134 is provided.

The artificial disc 130 is thus advantageous over the prior art, as thedisc results in a joint which is energetically stable or self centeringand which is biased back into a neutral position, where prior artartificial discs result in joints which are gravitationally unstable andbiased further from a neutral position once moved from neutral.Additionally, the artificial joints 130 results in a motion whichclosely approximates the natural motion of the spine. Matching moreclosely the natural motion of the spine reduces the adverse impact onthe tissue surrounding the artificial joint when in use and promotes thelong term success of the artificial joint.

FIG. 17 illustrates an alternate configuration of a projection 138 andrecess 146 of the artificial disc 130 to limit the range of motion ofthe resulting joint. The projection 138 has been formed with a roundedend 202 which more steeply curves away from the contact point with therecess 146. The recess 146 has been formed with an inner retaining wall206 and an outer retaining wall 210. The projection 138 will contact oneof the retaining walls after moving to an extreme position within therecess 146. Any or all of the recesses may be thus formed with retainingwalls to limit the movement of the upper surface 134 relative to thelower surface 142. Thus, the space between the retaining walls 206, 210and the projections 138 when the projection is in a resting positionwill determine range of motion of the upper surface 134, and of thejoint resulting from the artificial disc 130.

The retaining walls 206, 210 may extend completely around the recess 146and connect each other, or may be formed as separate structures. It willbe appreciated that inner retaining walls 206 may not be necessary. Ifeach of the recesses 146 is formed with an outer retaining wall 210, therange of movement of the projections 138 and upper surface 134 will belimited in all directions by the outer retaining walls 210. Similarly,outer retaining walls may not be necessary if the joint is completelyrestrained by inner retaining walls.

The inner retaining walls 206 may be used to more precisely control themovement of the projections 138 and upper surface 134 in selecteddirections. FIG. 18 shows such a use. For example, inner retaining walls206 b, 206 c may be placed on the inside sides of recesses 146 b, 146 c.The inner retaining walls 206 b, 206 c prevent movement of the lateralprojections 138 b, 138 c in a purely lateral direction. The innerretaining walls 206 b, 206 c are positioned against the lateralprojections 138 b, 138 c such that, in rotation, the lateral projections138 b 138 c do not translate laterally but rotate about a point ofcontact between a lateral projection and inner retaining wall.

For example, if the upper portion 134 is rotated to the right, thelateral projections 138 b, 138 c can not simply translate to the left orright. The left lateral projection 138 c may move forwards and to theright and the right lateral projection 138 b may move backwardssomewhat. The anterior projection 138 a may move to the right andforwards. The left lateral projection 138 c is raised vertically as itmoves, as discussed previously. It is thus seen that the inner retainingwalls 206 b, 206 c aid in constraining the movement of the artificialdisc to imitate the movement of the natural spine. The inner retainingwalls cause the center of rotation to be roughly between the retainingwalls, closer to the posterior end of the artificial disc, where thecenter of rotation of the natural spine is located.

In forwards and backwards flexing, the upper portion 134 should move asshown by arrows 214, 218, 222, in a manner similar to the natural spine.In rotation, the upper surface should move as shown by arrows 226, 230,234, also in a manner similar to that of the natural spine.

It will be appreciated that it may not be possible to perfectlyreplicate the movement of the natural spine and still achieve anartificial disc 130 which is sufficiently stable. As such, the resultingdesign may be a compromise between matching the natural motion andproviding inherent stability and self centering capabilities, forexample. An artificial joint may also be a compromise which provides agood match to the natural motion, inherent stability, and which may bemanufactured from a desired material without excessive expense ordifficulty. The present invention, however, does provide a markedimprovement over the inherently unstable artificial discs of the priorart and much more closely replicates the natural movements of the spine.

FIG. 19 shows another partially cut-away view of an artificial disc 130′of the present invention. The upper surface 134′ (FIG. 20) includes ananterior projection 138 d and a posterior projection 138 e. The lowersurface 142 includes an anterior recess 146 d and a posterior recess 146e. While the two projection/recess design may not provide an artificialjoint which is as stable as a three or more projection design, it stillprovides a marked improvement in stability and movement over aconventional artificial disc. For example, the elongate configuration ofthe projections 138 d and 138 e minimizes the effort necessary to centerthe joint compared to a hemispherical single projection as in the priorart.

FIG. 20 shows a cross sectional view of the artificial disc 130′ of FIG.19 along line 20-20. The projections 138 and recesses 146 configured asshown will cause the anterior projection 138 d to slide forwards (to theleft) and the posterior projection to slide forwards and upwards duringa forwards flexing of the artificial disc 130′, tilting the upperportion 134′ forwards and sliding the upper surface in a manner similarto the natural spine.

Similarly, the posterior projection 138 e will slide backwards and theanterior projection 138 d will slide backwards and upwards along therecesses 146 during a posterior flexing of the artificial disc, tiltingthe upper portion 134′ backwards and sliding the upper portion similarto the natural spine. The upward movement of the upper portion 134′during the forwards and backwards flexing of the artificial disc willmove the supported body against gravity, and cause gravity to bias theartificial disc back into a neutral position, as discussed above.

In rotation, the upper portion 134′ will rotate roughly around thecenter of the artificial disc 130′, and the upper disc will be raisedslightly as the edges of the projections 138 contact the inclinedportions of the recesses 146, causing gravity to bias the artificialdisc 130′ into a neutral position. By modifying the configuration of theprojections and recesses, the upper portion 134′ can be made to rotateabout an axis other than at the center of the upper portion. Thus, anartificial joint may be provided which more accurately resembles themovement of the natural spine.

It will be appreciated that the two projection artificial disc 130′ ofFIGS. 19 and 20 may not approximate the movement of the natural spinequite as closely as the three projection artificial disc 130 of FIGS. 8through 18, but it may be easier to manufacture. Furthermore, it remainsmore stable than the artificial joints of the prior art.

FIG. 21 shows a perspective view of another artificial disc which issimilar to that of FIGS. 8-18 and functions in a similar manner. Thedisc is different in that the anterior projection 234, as formed on thetop 238 of the joint, has a more abruptly terminated anterior side. Thebottom 242 is formed with a recess 246 which has a corresponding shape.The lateral projections 250, (254 not shown) and lateral recesses 258,262 may be formed with similar shapes as that of projection 234 andrecess 246, or may be more smoothly shaped as shown previously.

FIG. 22 shows a cross-sectional view of the joint of FIG. 21 taken alongline 22-22. It can be seen how the nearly vertical anterior side ofprojection 234 and the nearly vertical anterior side of the recess 246will prevent the upper portion 238 from moving more than a shortdistance to the right relative to the lower portion 242, providing amotion limit. Providing such a motion limit helps ensure that theartificial joint is not hyper-extended once installed into a patient. Ashas been discussed previously, the recess 246 may be shaped such thatthe projection 234 will move relatively horizontally when moving to theright from the neutral position shown, and such that the projectionmoves vertically as well as to the left when moving to the left relativeto the base and from the neutral position shown. As has been discussed,this creates a stable joint wherein compressive forces on the joint biasthe joint into a neutral position. It will be appreciated that one ormore of the projections and recesses may be formed in such a manner tothereby limit the motion of the joint. One or more of the differentmethods of limiting the motion of the artificial joint discussed hereinmay be used with any of the different joint configurations shown herein.

FIG. 23 shows another artificial disc 264 which uses a single projectionand a single recess to achieve the stability and motion controldiscussed herein. The top 266 includes a single recess 270, and thebottom 274 includes a single projection 278. The recess 270 andprojection 278 are formed with rounded and/or angled engaging surfacesso as to provide for smooth motion therebetween. The projection 278 andrecess 270 may be formed as polygonal shapes or other shapes to limitthe rotation of the artificial joint and provide more natural motion ofthe joint. It will be appreciated that a circular lobe 278 and recess270 will not limit the rotation of the top 266 relative to the bottom274 of the joint. The projection 278 and recess 270 may be formed asovals, squares, triangles, or other shapes.

FIG. 24 shows a cross sectional view of the artificial disc 264. It canbe seen how the recess 270 includes sloping outer wall 282 whichtransition from the center of the recess and rounded shoulders 286, andhow the projection 278 also has a sloping transitional region 290 androunded shoulders 294. The shoulder 294 of the projection contacts andslides across the sloping outer wall 282, and the shoulder 286 of therecess 270 contacts and slides across the sloping transition region 290of the projection.

In viewing the artificial joint 264, it can be appreciated that if thetop 266 is moved to the right relative to the bottom 272, the right sideof the top will move generally horizontally across the generallyhorizontal surfaces, and the left side of the top will be raised as theshoulders 286, 294 engage and move across the sloping transition regions282, 290. This will be the case for lateral bending or flexion/extensionof the artificial joint 264. Thus, the artificial joint 264, while notperfectly approximating the natural motion of the spine, will create asimilar motion and will create a joint which is biased into the neutralposition shown by compressive forces applied to the joint (as is thecase when a joint is installed in a human spine). In order to bettercontrol the motion of the artificial joint 164, the upper portion 266may be curved away from the contact points on the shoulders 286 asindicated at 292. Additionally, the lower portion 274 may slopedownwardly in the posterior portion as indicated at 296 so as to moreclosely approximate the natural motion of the spine.

FIG. 25 shows a bottom view of a top portion 298 of an artificial jointsimilar to that shown in FIGS. 23 and 24. It can be seen how the recess302 (and the corresponding projection formed on the bottom of the joint)may be formed in shapes other than a square or rectangular shape asshown previously. Different shapes of projections and recesses willalter the characteristic motion of the resulting joint. For example, aprojection/recess shaped as shown may tend to lift more when moving inone direction than in the opposite direction or provide differentrotational characteristics during rotation or lateral bending of thejoint. Thus, a shape may be selected which reasonably approximates themotion of the natural spine and creates a joint which is biased into aneutral position by compressive forces, but which is also a relativelysimple shape to manufacture.

FIG. 26 illustrates the use of an artificial joint 306 of the presentinvention used to replace the nucleus of a damaged spinal disc, whileleaving the annulus 310 (annulus fibrosis) of the natural disc in place.Leaving the annulus 310 as intact as is possible may be advantageous insome cases as it provides support to the artificial joint 306, helpingto keep the joint 306 centered over the vertebra 314 or helping to keepthe top of the joint centered over the bottom of the joint. Anartificial joint which is used for a nuclear replacement will typicallybe smaller than a joint used for a total disc replacement. Any of thejoint designs shown above may be used as either a total disc replacementor a nuclear replacement if manufactured in the appropriate size andconfiguration and made of an appropriate material.

FIG. 27 illustrates an artificial disc 318 with an elastomeric band 322surrounding the joint 318. The band 322 may aid in loosely constrainingthe motion of the joint and in keeping the top of the joint centeredabove the bottom of the joint. Any of the above joint designs mayincorporate such a band 322 if desired.

FIG. 28 illustrates an alternate artificial disc according to thepresent invention. The artificial joint 326 includes a base portion 330having a circular recess 332 formed therein, a toroid 334, and a top 338which includes a conical or frusto-conical portion that nests in thetoroid 334. The toroid 334 can translate across the base 330 but isbiased into the center of the base by compressive forces. The top 338may pivot inside of the toroid 334 and is elevated as it pivots becauseof the interaction between the conical portion and the toroid.

FIG. 29 illustrates the joint of FIG. 28 in a position corresponding toa flexion/extension or lateral bending motion. It can be seen how thetoroid 334 is elevated as it slides across the recess 332 in the base330, and how the top 338 is elevated as it pivots. The joint 326utilizes symmetrical shapes which may be relatively easy to manufactureand roughly approximates the natural spinal motion. Theflexion/extension and lateral bending of the joint closely approximatethe natural spine, and are also biased into a neutral position. Whilethe rotation is unconstrained, this motion may be the easiest for themuscles and surrounding tissue to control and is the least affected bythe compressive forces placed on the natural spine.

Turning now to FIG. 30, an exploded perspective view of anotherartificial joint is shown. The joint, indicated generally at 350, issimilar to the artificial joints shown in FIGS. 8-22. The joint 350includes an upper portion 354 having an anterior projection 358 and twolateral projections 362. The joint 350 also includes a lower portion 366which includes an anterior recess 370 and two lateral recesses 374,which may be connected together into a single recess as is shown. Itwill be appreciated, however, that the narrow connecting portion asshown does not contribute to the motion of the artificial disc and is amanufacturing convenience. The joint functions as has been discussedpreviously with respect to FIGS. 8 through 18. That is to say that theupper portion 354 slides across the lower portion 366 allowinganterior-posterior, lateral, and rotating translational movements. Asthe upper portion 354 slides across the lower portion 366, theprojections 358, 362 are also typically moved vertically relative to thelower portion 366 due to the curved surfaces of the recesses 370, 374.As will be shown in the following figures, the projections 358, 362 aregenerally spherical and the recesses 370, 374 have circular verticalcross sections. This results in an artificial joint 350 which closelymatches the natural motion of the spine and provides inherent stabilityas discussed above but which is easier to manufacture.

Similar to the artificial joints of FIGS. 8-22, the projections 358, 362are moved upwardly relative to the lower portion 366 as they movetowards the center of the lower portion. This vertical movement resultsin a net expansion of the artificial joint, and thus results in a jointwhere compressive forces applied to the joint bias the joint backtowards a neutral position. This vertical motion also results in a jointwhich provides motion that more closely matches the natural kinematicmotion of the human spine. It will be appreciated that the slopes andchanges of curvature in the recesses 370, 374 may be adjusted to controlthe amount of vertical movement generated by a particular horizontalmovement.

FIGS. 31 through 34 show additional details of the upper portion 354 ofthe joint 350 of FIG. 30. FIG. 31 is a bottom view of the upper portion354. FIGS. 32 and 33 are cross sectional views taken along section lines32 and 33 of FIG. 31. FIG. 34 is a perspective view of the upper portion354. One advantage of the joint 350 is that it uses a somewhat simplerand more uniform surface shape and geometry than the joints of FIG. 11while achieving a motion which closely replicates the motion of thenatural spine. The upper portion may be formed as a substantially flatdisc with semi-spherical projections 358, 362. The semi-sphericalprojections 358, 362 are more easily shaped and polished that the morecomplex projections such as are shown in FIG. 11, for example.

FIGS. 35 through 40 show additional details of the lower portion 366 ofthe joint 350 of FIG. 30. FIG. 35 shows a top view of the lower portion366 and FIGS. 36 through 39 are cross sectional views of FIG. 35 takenalong section lines 36-39, respectively. FIG. 40 is a perspective viewof the lower portion 366. As can be seen in FIGS. 30 and 35 through 40,the two lateral recesses 374 may be connected together across the backlower portion 366 of the artificial joint. While the lateral projections362 may never move fully to the back of the lower portion 366 directlybetween the lateral recesses 374, it may be easier to form and polishthe joint with such a configuration.

It can be observed from FIGS. 36 through 39 that the contact surface 378of the anterior recess 370 (across which anterior projection 358 slidesduring articulation of the joint) is gently curved and sloped. Thecontact surface 378 of recess 370 allows the projection 358 to movedownwardly as is slides away from the center of the lower portion 366and upwardly as it slides towards the center of the lower portion, suchas during flexion and extension of the joint, as well as upwardly as itmoves laterally across the lower portion, such as during rotation of thejoint. The curvature of the contact surface 370 results in greatervertical movement per unit of horizontal movement when the projection358 is closer to the center of the lower portion 366 as compared to whenthe projection 358 is closer to the outer edge of the lower portion.

In order to facilitate easier manufacture of the lower portion 366, therecesses 370, 374 may each have a circular vertical cross section as isvisible in FIGS. 37 through 39. This allows a circular grinding orpolishing tool to be swept across the lower portion during manufacturein order to form the recesses.

It can be observed from FIGS. 36-39 that the contact surfaces 382 of thelateral recesses 374 have smaller radii of curvature than that ofcontact surface 378 of anterior recess 370. As such, the contactsurfaces 382 of the lateral recesses 374 are horizontal or nearlyhorizontal near the outer edges of the lower portion 366 and moresteeply sloped near the center of the lower portion. As a result, thelateral projections 362 experience little or no vertical movement asthey move across the surface 382 away from the center of the lowerportion 366 and move upwardly away from the lower portion 366 of thejoint as they move towards the center of the lower portion. Thecurvature of the contact surfaces 382 is such that the vertical movementof the lateral projections 362 is greater per unit of horizontalmovement when the lateral projections are closer to the center of thelower portion 366.

The steeper slope of the more central portions of contact surfaces 382as compared to contact surface 378 provides a net restoring force whichbiases the artificial joint 350 to a neutral position (i.e. anun-displaced position). Thus, the slope of contact surface 378 will tendto bias the anterior projection 358 away from the center of the lowerportion even in a neutral position, but the greater slopes of thelateral contact surfaces 382 will provide a greater bias against furtheranterior displacement to the lateral projections 362 and maintain thejoint in a neutral position while compression is applied to theartificial joint 350.

The shapes and curvatures of the contact surfaces 378, 382 of therecesses 370, 374 results in a kinematic movement of the artificialjoint 350 which approximates that of the natural spine and which alsotends to return the artificial joint 350 to a neutral position when thejoint 350 is placed under compression. A neutral position is where theupper portion is aligned over the lower portion and not displaced fromthe center thereof. (It will be appreciated that upper or lower portionsmay have a base which is shifted somewhat from the projections so thatthe upper and lower base portions are somewhat misaligned even thoughthe projections and recesses are in a neutral orientation. Such iswithin the scope of the invention.) In use, the artificial joint 350will be biased towards an un-displaced, neutral position by thecompressive forces placed upon the joint by the body and will thereforestabilize the joint. The artificial joint 350 presents a goodapproximation of the natural movement of the spine, i.e. the rotationand translation which occurs with lateral bending or rotation of thespine and the translation which occurs with flexion and extension of thespine.

Turning now to FIGS. 41 through 53, another artificial spinal joint 386of the present invention is shown. The artificial joint 386 operatesaccording to the principles discussed above in that the artificial jointprovides a motion that closely matches the natural motion of the spineand which is inherently stable. The joint 386 is stable in that thejoint experiences a net expansion as a result of the intended ranges ofmotion and thus the compressive forces placed on the joint while in aspine will tend to restore the joint to a neutral, unbiased position.

FIGS. 42 through 46 show the upper portion 390 of the joint 386 of FIG.41 while FIGS. 48 through 53 shows the lower portion 394 of the joint.FIG. 42 shows a perspective view of the upper portion 390. FIG. 43 showsa bottom view of the upper portion 390 and FIGS. 44 through 47 showcross sectional views of the upper portion taken along section lines 44through 47 of FIG. 43. Similarly, FIG. 48 shows a perspective view ofthe lower portion 394 while FIG. 49 shows a top view of the lowerportion 394 and FIGS. 50 through 53 shows cross sectional views of thelower portion taken along section lines 50 through 53 of FIG. 49.

The joint 386 differs from the joints discussed above in FIGS. 8 through18 and 30 through 40 in that it contains a single posterior projection398 and posterior recess 406 and two anterior lateral projections 402and two anterior lateral recesses 410. Otherwise, the upper portion 390and lower portion 394 mate together in a similar manner and function ina similar manner to that discussed above.

The joint 386 includes two anterior projections 402 and a singleposterior projection 398 and corresponding recesses so as to betterutilize the stabilizing effects of the facet joints (52 of FIG. 3).During forward flexion of the joint 386, more pressure is placed on thetwo anterior projections 402 and anterior recesses 410, providinggreater lateral stability. During backwards extension of the joint 386,more pressure is placed on the single posterior projection 398 andposterior recess 406 which results is somewhat less lateral stabilitythan is provided in forward flexion of the joint. However, the facetjoints 52, which are found on the posterior of the spine, provideadditional lateral stability during extension of the joint 386. Thus,the two lateral projections 402 and recesses 410 are better utilized onthe anterior of the joint 386.

Otherwise, the joint 386 of FIGS. 41 through 53 is similar to the joint350 of FIGS. 30 through 40. As illustrated in FIGS. 44 through 47, theprojections 398, 402 have spherical shapes to allow for easier grindingand polishing of the upper portion 390 when a material such aspolycrystalline diamond (PDC) is used. The recesses have circularvertical cross sections as illustrated in FIGS. 50 through 53 so as toallow for easier grinding and polishing with a circular rotary tool whenusing PDC or a similar material. The rotary tool may be swept through arelatively simple horizontal motion to grind the recess shapes shown.The joint 386 has been cut to a trapezoidal shape as such a shapeclosely matches the available space in the spine for total discreplacement. It will be appreciated that all of the preceding inventiveartificial joints, while shown round for ease in drawing and discussingthe joints, may be formed in a generally trapezoidal or generallyrectangular shape as shown so as to most efficiently interface with thevertebral bodies.

Turning now to FIGS. 54 through 66, another artificial spinal joint ofthe present invention is shown. FIG. 54 shows a perspective view of thejoint 414. FIGS. 55 through 60 show the upper portion 418 of the joint414 while FIGS. 61 through 66 show the lower portion 422 of the joint414. FIG. 55 shows a perspective view of the upper portion 418. FIG. 56shows a bottom view of the upper portion 418 and FIGS. 57 through 60show cross sectional views of the upper portion taken along sectionlines 57 through 60 of FIG. 56. Similarly, FIG. 61 shows a perspectiveview of the lower portion 422 while FIG. 62 shows a top view of thelower portion 422 and FIGS. 63 through 66 shows cross sectional views ofthe lower portion taken along section lines 63 through 66 of FIG. 62.

The joint 414 is similar to the joint 386 discussed above in that itcontains a single posterior projection 426 and posterior recess 434 andtwo anterior lateral projections 430 and two anterior lateral recesses438. The joint 414 is different in that the projections 426, 430 andrecesses 434, 438 are larger that those of the joint 386 so as tofurther lower the contact pressure of the joint and further reduce thestress placed on the material used to construct the joint.

The projections 426, 430 are spherical in shape and the recesses 434,438 have circular vertical cross sections so as to allow for simplifiedgrinding and polishing as discussed above, and provide the desiredmotion as described in the present application to closely match thenatural motion of the spine. In order to maximize the stability of thejoint 414, the projections 426, 430 and recesses 434, 438 have beenmoved close to the edges of the upper portion 418 and lower portion 422while still maintaining a desired range of motion. This increases the‘footprint’ of the contact points and maximizes the forces which tend torestore the joint to a neutral position when the joint is compressed.

By way of example, the following dimensions have been found to produce asuitable artificial joint for total disc replacement of cervical spinediscs. The upper portion 418 and lower portion 422 are about 15.5 mmwide and about 11.9 mm long (front to back). The relatively flat base442 of the upper portion 418 (extending between the projections 426,430) is approximately 1.9 mm thick. On the upper portion 418, theposterior projection 426 is approximately 11.2 mm in diameter, and has acenter which is located along the lateral centerline, and positionedabout 1.7 mm from the posterior edge of the upper portion. The posteriorprojection 426 is placed such that it extends approximately 3.6 mm fromthe base portion 442, to a total combined thickness of about 5.5 mm.

The two anterior lateral projections 430 are approximately 6.9 mm indiameter, and have centers which are located about 7.2 mm in front ofthe center of the posterior projection 426 and laterally about 5.35 mmfrom the lateral centerline of the upper portion 418. The anteriorlateral projections 430 extend about 2.9 mm from the base portion 442,to a total combined thickness of about 4.8 mm. Section lines 57 through60 on FIG. 56 pass through the centers of the projections 426, 430.

FIGS. 67 and 68 illustrate the grinding/polishing tool paths used toform the lower section 422 as shown. FIG. 67 shows a top view of thetool paths overlaid on the lower portion 422 of the joint, and FIG. 68shows a perspective view of the tool paths along with the resulting toolcuts and recesses. The posterior recess is made by sweeping a 15 mmdiameter circular grinding/polishing tool through a horizontal arc 450(so that the grinding diameter is perpendicular to the arc) where thearc has approximately a 1.8 mm radius and where the center 454 of thearc is centered laterally on the lower portion 422, positioned 6.4 mmbehind central reference point 446 (which is centered laterally andabout 5.4 mm from the anterior edge or 6.6 mm from the posterior edge),and so that the center 454 is positioned about 4.9 mm above the uppersurface of the lower portion 422. The portion 458 of the posteriorrecess 434 which is inside of the lowest point ground by the tool isground flat.

The two lateral anterior recesses 438 are made by sweeping a 10.8 mmdiameter circular grinding/polishing tool across the tool pathidentified by path segments 462 a, 466 a, 470 a, 474 a, 474 b, 470 b,466 b, and 462 b. Tool path segments 462 a, 462 b are straight lines ofabout 3.5 mm length. Tool path segments 466 a, 466 b are arcs havingcenters 478 a, 478 b and radii of about 0.9 mm. Tool path segments 470a, 470 b are straight lines about 1.7 mm in length. Tool path segments474 a, 474 b are arcs having a common center 482 and radii of about 6mm. Center points 478 a, 478 b are located about 7 mm to each side ofthe lateral center line and are located about 4 mm forward of thereference point 446, placing the points about 10.6 mm forward of thecenter point 454 and about 1.4 mm back from the anterior edge of thelower portion 422. Center point 482 is located along the lateral centerline and about 5.9 mm forwards of the reference point 446, or about 0.3mm forwards of the anterior edge of the lower portion 422.

The various tool path segments 462 through 474 are connected into acontinuous path as shown, and are located in a single plane. The planein which the tool path segments are located is angled with respect tothe lower segment so as to angle the forward portion 438 a of theanterior recesses 438 as shown in FIG. 64. As discussed previously, thiscauses the anterior end of the upper portion 418 to lower slightlyrelative to the anterior end of the lower portion 422 during flexion ofthe spine, replicating the natural motion of the spine. For theembodiment shown in FIGS. 54 through 68, the plane is sloped downwardlyabout 17 degrees towards the anterior side of the joint. As such, theanterior most point 486 of the tool path (path segments 462 through 474)is located about 0.9 mm above the upper surface of the lower portion422, and the path segments 470 a, 470 b are located about 3.5 mm abovethe upper surface of the lower portion.

It will be appreciated that the slope of the plane in which the toolpath segments 462 through 474 are located may be zero if a simplifiedmanufacturing process is desired. When the plane of the tool pathsegments 462 through 474 is sloped, it may typically be adjusted tomatch the specific disc which is being replaced, and may often be slopedat an angle of between about 7 and about 27 degrees less thanhorizontal. As discussed above, a middle cervical artificial disc willhave a slope of about 17 degrees. The slope of the plane will typicallybe changed by adjusting the height of the anterior most point 486 of thetool path so as to keep the anterior recesses 438 at a similar averageheight and keep the height of the upper portion 418 relative to thelower portion 422 at a similar distance when the upper portion is in aneutral position.

The artificial spinal joints herein are beneficial in that they providemotion which closely replicates the artificial motion of the spine. Animportant aspect of this is providing a coupled motion, wheretranslation or rotation of the upper portion relative to the lowerportion necessarily produces a tilting of the upper portion relative tothe lower portion. While some prior art artificial spine joints allowfor translation, and allow for pivoting of the joint in a ball andsocket like manner, there is no coupling of the translational movementand pivoting movement which approximates the natural motion of thespine. This results in a joint that provides an unnatural motion whenimplanted in a spine, and which adversely affects the spine as describedherein. To the contrary, the inventive artificial spine joints provide amotion that closely replicates the natural spinal motion.

It is appreciated that the artificial discs disclosed herein will resultin a high contact pressure between the projections and the recesses, asthe curved surfaces of the projections contact the recesses at a verysmall contact area. Thus, the material used to create such a projectionmust withstand a very high pressure without deformation and without thewearing away, breaking, or other degradation of the material. Thus, apreferred embodiment of the present invention provides artificial discswhich are formed from diamond, such as polycrystalline diamond compact(PDC). PDC is a sufficiently hard material to resist wear anddeformation.

U.S. Publication No. 2003/0191533, assigned to Diamicron, Inc.,discusses the manufacture of artificial joints using diamond, and isincorporated herein by reference. The publication makes known to one ofskill in the art how to make artificial joints of artificial diamonds.With respect to the present invention, it is appreciated that it is moredifficult to form a diamond artificial disc surface which is acomplicated multi-projection or multi-recess surface. It is much simplerto form a simple regular surface such as a sphere or hemisphericalreceptacle.

A presently preferred method of manufacture of the artificial disc ofthe present invention uses electrical discharge machining (EDM) to formthe joint surfaces. The artificial diamond compound may be pressed intoroughly the desired shape. A sink EDM machine may then be fitted with anelectrode which is the negative shape of the part being produced. TheEDM and custom electrode are then used to burn away the diamond compoundand refine the shape of the piece of the artificial joint. The resultingpiece may then be polished to a finished surface. It is thus appreciatedthat the difficulty of forming the artificial disc out of diamond is adifficult process and may require some simplification of the artificialdisc design.

Another currently preferred method of manufacture of the artificialjoint of the present invention uses a circularly shaped grinding andpolishing tool to sweep across the recesses and form the curved contactsurfaces therein, and used a cup shaped grinding and polishing tool toform the spherical projections on the lower surfaces. This isparticularly advantageous in forming the more geometrically shapedcontact surfaces of the artificial joints of FIGS. 31 through 66.

While PDC or other diamond materials are preferred, other biologicallycompatible metals and ceramics may also be used. Those familiar with theconstruction of artificial joints will be familiar with numerous suchmaterials and the relative advantages and drawbacks of each.

There is thus disclosed an improved artificial vertebral disc. It willbe appreciated that numerous changes may be made to the presentinvention without departing from the scope and spirit of the invention.The appended claims are intended to cover such modifications.

1.-51. (canceled)
 52. An artificial disc for spinal implantationcomprising: a first upper joint member having a first side defining anattachment surface attachable to a vertebra and having a second sidehaving a first articulation surface; and a second lower joint memberhaving a first side defining an attachment surface attachable to avertebra and having a second side having a second articulation surface;wherein the first articulation surface engages the second articulationsurface in sliding engagement to allow for movement of the artificialdisc; and wherein the artificial disk experiences constrained couplingof movement such that lateral bending of the upper joint member relativeto the lower joint member causes lateral translation of the upper jointmember relative to the lower joint member in the same direction as thelateral bending.
 53. The artificial disc of claim 52, wherein saidlateral bending also causes axial rotation of the upper joint memberrelative to the lower joint member whereby a point on the anterior edgeof the upper joint member moves due to said rotation in the samedirection as the lateral bending movement.
 54. The artificial disc ofclaim 52, wherein said lateral translation causes a point of contactbetween the upper joint member and the lower joint member to move in thesame direction as the lateral bending.
 55. The artificial disc of claim52, wherein said lateral bending also causes a point at the center ofthe upper joint member to move upwardly away from the lower joint memberto increase the distance between the upper joint member and the lowerjoint member.
 56. The artificial disk of claim 52, wherein the firstarticulation surface comprises two anterior projections which are spacedapart from each other and a posterior projection and the secondarticulation surface comprises two anterior recesses which are spacedapart from each other and a posterior recess.
 57. The artificial disk ofclaim 52, wherein the first articulation surface comprises a pluralityof projections and the second articulation surface comprises a pluralityof recesses which correspond to the plurality of projections and whereinthe plurality of projections move translationally within the pluralityof recesses.
 58. The artificial disk of claim 52, wherein the firstarticulation surface comprises a plurality of projections and the secondarticulation surface comprises a plurality of recesses which correspondto the plurality of projections and wherein the plurality of projectionscomprise three projections and the plurality of recesses comprise threerecesses.
 59. The artificial disk of claim 52, wherein the firstarticulation surface comprises a plurality of projections and the secondarticulation surface comprises a plurality of recesses which correspondto the plurality of projections and wherein the plurality of recesseshave an outer portion adjacent an outer periphery of the joint memberwhich is generally parallel to the attachment surface and wherein theplurality of recesses have an inner portion adjacent a center of thejoint member which is curved and extends away from the attachmentsurface.
 60. An artificial disc for spinal implantation comprising: afirst joint member having a first side defining an attachment surfaceattachable to a vertebra and having a second side having a firstarticulation surface; and a second joint member having a first sidedefining an attachment surface attachable to a vertebra and having asecond side having a second articulation surface; wherein the firstarticulation surface engages the second articulation surface in slidingengagement to allow for movement of the artificial disc; and wherein theartificial disk experiences constrained coupling of movement such thataxial rotation of the of the upper joint member relative to the lowerjoint member causes lateral tilting of the upper joint member in thesame direction as the movement of a point on the anterior edge of theupper joint member due to the axial rotation.
 61. The artificial disc ofclaim 60, wherein said axial rotation also causes a point at the centerof the upper joint member to move upwardly away from the lower jointmember to increase the distance between the upper joint member and thelower joint member.
 62. The artificial disk of claim 60, wherein thefirst articulation surface comprises a plurality of projections and thesecond articulation surface comprises a plurality of recesses whichcorrespond to the plurality of projections, and wherein the plurality ofprojections move translationally within the plurality of recesses. 63.The artificial disk of claim 60, wherein the first articulation surfacecomprises a plurality of projections and the second articulation surfacecomprises a plurality of recesses which correspond to the plurality ofprojections, and wherein the plurality of projections comprise threeprojections and the plurality of recesses comprise three recesses. 64.The artificial disk of claim 60, wherein the first articulation surfacecomprises a plurality of projections and the second articulation surfacecomprises a plurality of recesses which correspond to the plurality ofprojections, and wherein the plurality of recesses have an outer portionadjacent an outer periphery of the joint member which is generallyparallel to the attachment surface and wherein the plurality of recesseshave an inner portion adjacent a center of the joint member which iscurved and extends away from the attachment surface.
 65. An artificialdisc for spinal implantation comprising: a first joint member having afirst side defining an attachment surface attachable to a vertebra andhaving a second side having a first articulation surface; and a secondjoint member having a first side defining an attachment surfaceattachable to a vertebra and having a second side having a secondarticulation surface; wherein the first articulation surface engages thesecond articulation surface in sliding engagement to allow for movementof the artificial disc; and wherein the artificial disk experiencesconstrained coupling of movement such that anterior flexion of the upperjoint member relative to the lower joint member causes anteriortranslational movement of the upper joint member relative to the lowerjoint member and such that posterior flexion of the upper joint memberrelative to the lower joint member causes posterior translationalmovement of the upper joint member relative to the lower joint member.66. The artificial disc of claim 65, wherein said anterior flexion alsocauses a point at the center of the upper joint member to move upwardlyaway from the lower joint member to increase the distance between theupper joint member and the lower joint member, and wherein saidposterior flexion also causes a point at the center of the upper jointmember to move upwardly away from the lower joint member to increase thedistance between the upper joint member and the lower joint member. 67.The artificial disk of claim 65, wherein the first articulation surfacecomprises a plurality of projections and the second articulation surfacecomprises a plurality of recesses which correspond to the plurality ofprojections, and wherein the plurality of projections movetranslationally within the plurality of recesses.
 68. The artificialdisk of claim 65, wherein the first articulation surface comprises aplurality of projections and the second articulation surface comprises aplurality of recesses which correspond to the plurality of projections,and wherein the plurality of projections comprise three projections andthe plurality of recesses comprise three recesses.
 69. The artificialdisk of claim 65, wherein the first articulation surface comprises aplurality of projections and the second articulation surface comprises aplurality of recesses which correspond to the plurality of projections,and wherein the plurality of recesses have an outer portion adjacent anouter periphery of the joint member which is generally parallel to theattachment surface and wherein the plurality of recesses have an innerportion adjacent a center of the joint member which is curved andextends away from the attachment surface.